Surgeon Upper Extremity Kinematics During Error and Error-Free Retropubic Trocar Passage.

INTRODUCTION AND HYPOTHESIS: Surgeon kinematics play a significant role in the prevention of patient injury. We hypothesized that elbow extension and ulnar wrist deviation are associated with bladder injury during simulated midurethral sling (MUS) procedures. METHODS: We used motion capture technology to measure surgeons' flexion/extension, abduction/adduction, and internal/external rotation angular time series for shoulder, elbow, and wrist joints. Starting and ending angles, minimum and maximum angles, and range of motion (ROM) were extracted from each time series. We created anatomical multibody models and applied linear mixed modeling to compare kinematics between trials with versus without bladder penetration and attending versus resident surgeons. A total of 32 trials would provide 90% power to detect a difference. RESULTS: Out of 85 passes, 62 were posterior to the suprapubic bone and 20 penetrated the bladder. Trials with versus without bladder penetration were associated with more initial wrist dorsiflexion (-27.32 vs -9.03°, p = 0.01), less final elbow flexion (39.49 vs 60.81, p = 0.03), and greater ROM in both the wrist (27.48 vs 14.01, p = 0.02), and elbow (20.45 vs 12.87, p = 0.04). Wrist deviation and arm pronation were not associated with bladder penetration. Compared with attendings, residents had more ROM in elbow flexion (14.61 vs 8.35°, p < 0.01), but less ROM in wrist dorsiflexion (13.31 vs 20.33, p = 0.02) and arm pronation (4.75 vs 38.46, p < 0.01). CONCLUSIONS: Bladder penetration during MUS is associated with wrist dorsiflexion and elbow flexion but not internal wrist deviation and arm supination. Attending surgeons exerted control with the wrist and forearm, surgical trainees with the elbow. Our findings have direct implications for MUS teaching.

Cognitive models for mentally visualizing a sharp instrument in a blind procedure.

Purpose: Our objective was to understand the cognitive strategies used by surgeons to mentally visualize navigation of a surgical instrument through blind space. Methods: We conducted semi-structured interviews with 15 expert and novice surgeons following simulated retropubic trocar passage on 3D-printed models of pelvises segmented from preop MRIs. Midurethral sling surgery involves blind passage of a trocar among the urethra, bladder, iliac vessels, and bowel while relying primarily on haptic feedback from the suprapubic bone (SPB) for guidance. Our conceptual foundation was based on Lahav's study on blind people's mental mapping of spaces using haptic cues. Participants detailed how they mentally pictured the trocar's location relative to vital anatomy. We coded all responses and used constant comparative analysis to generate themes, confirmed with member checking. Results: Expert and novice participants utilized multiple cognitive strategies combined with haptic feedback to accomplish safe trocar passage. Some used a step-by-step route strategy, visualizing sequential 2D axial images of anatomy adjacent to the SPB. Others used a map strategy, forming global 3D pictures. Although these mental pictures vanished when they were "lost," a safe zone could be reestablished by touching the SPB. Experts were more likely to relate their body position to the trocar path and rely on minor variations in resistance. Novices were more inclined toward backtracking of the trocar. Conclusions: Our findings may be extended to any blind surgical procedure. Teaching visualization strategies and incorporating tactile feedback can be used intraoperatively to help learners navigate their instrument safely around vital organs.

Surgeon estimation of retropubic trocar position in blind 3D space.

INTRODUCTION AND HYPOTHESIS: Retropubic midurethral sling surgery involves the blind passage of trocars near vital organs. We quantified the proximity of surgeons' mental representation of trocar position relative to actual position using a pelvis simulation platform. We hypothesized that novice surgeons, compared with experts, would estimate the trocar's location to be further from the actual location. METHODS: Novice and expert surgeons performed bilateral retropubic trocar passes of a Gynecare TVT trocar (#810041B-#810,051) on the simulation platform. We measured the trocar tip's position using a motion capture system, and recorded vocalizations when they perceived contacting the bone and crossing three landmark-oriented planes. We calculated differences (∆Bone, ∆Turn, ∆Top, ∆Pop) between vocalization times and when the trocar crossed the corresponding plane. We performed Mann-Whitney and Chi-squared tests to investigate differences between novices and experts and Levene's test to assess equality of variances for subject-level variation. RESULTS: A total of 34 trials, including 22 expert and 12 novice trials, were performed by six participants. ∆Bone was significantly smaller among novice surgeons (1.27 vs 2.81 s, p=0.013). There were no significant differences in the remaining three deltas or in vocalizing early versus late. Levene's test revealed no significant differences in within-subject variability for any of the four deltas. Novices passed the trocar anterior to the pubic bone on three passes. CONCLUSIONS: Novices were similar to expert surgeons in their estimation of the trocar's location and may have relied more heavily on anticipatory mechanisms to compensate for lack of experience. Teaching surgeons should make sure the novice surgeon trocar pass starts posterior to the bone.

Retropubic trocar modified with a load cell to verify contact with pubic bone.

BACKGROUND: Vital injuries during midurethral sling surgery are avoided by maintaining constant trocar contact with bone, and yet this is challenging for a teaching surgeon to monitor during this blind procedure. We modified a retropubic trocar with a load cell to distinguish on-bone and off-bone movement and tested it on a midurethral sling surgery 3-dimensional surgery simulator. METHODS: Two experts and 3 novice surgeons performed retropubic trocar passage on the physical pelvic floor model using the modified trocar. Biofidelity was assessed comparing expert performance on a Thiel-embalmed cadaver and the physical model. The test-retest was assessed comparing performance on the physical pelvic model 2 weeks apart. The force variables were analyzed with paired and independent t tests. We performed post hoc analyses comparing the experts to novices on the physical model. RESULTS: The root-mean-squared force was similar between the cadaver and model (24.3 vs 21.1 pounds, P = .62), suggesting biofidelity. Root-mean-squared force was also similar between the test and retest (14.0 vs 19.1 pounds, P =. 30). The expert surgeons exhibited a larger maximum force amplitude (51.2 vs 22.7 pounds, P = .03), shorter time to maximum force (2.7 vs 9.5 seconds, P = .03) and larger maximum rate of force development (171.5 vs 54.0 pounds/second, P = .01). CONCLUSION: This study suggested high test-retest reliability and adequate biofidelity of the modified trocar used on our midurethral sling surgery 3-dimensional surgery simulator. This innovative trocar can be used both in simulation and in the operating room to help the novice surgeons stay on the bone and to help the attending surgeon monitor safe surgery.

Mortality of Dairy Sheep during the Peri-Parturient Period: Results of a Field Investigation in Greece.

Objectives of the study were (a) to investigate the incidence risk of peri-parturient mortality in dairy flocks in Greece, (b) to study when such mortality occurs in relation to lambing, (c) to identify clinical problems associated with the deaths, and (d) to evaluate potentially associated factors. The deaths of ewes during the peri-parturient period (10 days before to 7 days after lambing) were monitored in 60 flocks over two years. In the ewes that died, detailed post-mortems were performed. The incidence risk of peri-parturient deaths was 0.7%. The daily incidence rate of deaths before, at, and after lambing was 0.05, 0.04, and 0.03%, respectively. Clinical problems most frequently associated with peri-parturient deaths were pregnancy toxaemia, ruminal acidosis and post-partum genital problems. For the occurrence of peri-parturient deaths in flocks, the average lambing rate in the flocks was the only significant factor. Regarding deaths before or after lambing, the season during which lambing took place and the number of animals in the flock, respectively, were found to be significant. Most ewes (54.5%) that died at lambing (dystocia) were primigravidae.

Extensive countrywide field investigation of somatic cell counts and total bacterial counts in bulk tank raw milk in goat herds in Greece.

Dairy goat farming is an important sector of the agricultural industry in Greece, with an annual total milk production exceeding 450 000 l and accounting for over 25% of all goat milk produced in the European Union; this milk is used mainly for cheese production. Despite the importance of goat milk for the agricultural sector in Greece, no systematic countrywide investigations in the bulk-tank milk of goats in Greece have been reported. Objectives were to investigate somatic cell counts (SCC) and total bacterial counts (TBC) in raw bulk-tank milk of goat herds in Greece, study factors influencing SCC and TBC therein and evaluate their possible associations with milk content. Throughout Greece, 119 dairy goat herds were visited for milk sampling for somatic cell counting, microbiological examination and composition measurement. Geometric mean SCC and TBC were 0.838 × 106 cells ml-1 and 581 × 103 cfu ml-1, respectively. Multivariable analyses revealed annual frequency of check-ups of milking system and total milk quantity per goat (among 53 variables) to be significant for increased SCC; no factor emerged (among 58 variables) to be significant for increased TBC. Negative correlation of SCC with total protein was found; mean total protein content in the bulk-tank milk in herds with SCC >0.75 × 106 cells ml-1 was 5.1% lower and in herds with SCC >1.5 × 106 cells ml-1, it was 7.8% lower.

Association of Staphylococcal Populations on Teatcups of Milking Parlours with Vaccination against Staphylococcal Mastitis in Sheep and Goat Farms.

There is a paucity of information regarding staphylococcal populations on teatcups of milking parlours in sheep and goat farms. The objectives were to describe the populations of staphylococci on teatcups in milking parlours in sheep or goat farms in two field investigations throughout Greece and to potentially associate the findings with the use of anti-staphylococcal mastitis vaccinations in the farms visited during the two investigations. In a cross-sectional (255 sheep and 66 goat farms across Greece) and a longitudinal (12 sheep farms, four samplings, throughout lactation) study, swab samples were collected from 1418 teatcups (upper and lower part) for staphylococcal recovery, identification and assessment of biofilm-formation. A total of 328 contaminated teatcups (23.1%) were found in 105 sheep (41.2%) and 35 goat (53.0%) farms. Staphylococci were more frequently recovered from the upper than the lower part of teatcups: 269 versus 139 teatcups, respectively. After identification, 253 staphylococcal isolates were found: Staphylococcus aureus, Staphylococcus equorum, Staphylococcus lentus, and Staphylococcus capitis predominated. Of these isolates, 87.4% were biofilm-forming. The proportion of contaminated teatcups was smaller in farms where vaccination against anti-staphylococcal mastitis in general or vaccination specifically against mastitis caused specifically by biofilm-forming staphylococcal strains was applied, 19.7% or 10.9%, respectively, versus 25.5% in farms without vaccination. In the longitudinal study, contaminated teatcups were identified in 28 (58.3%) sampling occasions, with staphylococci being recovered more frequently from their upper part. The same species as in the cross-sectional study predominated. Of these isolates, 61.9% were biofilm-forming. In farms where vaccination against mastitis caused specifically by biofilm-forming staphylococcal strains was applied, the proportion of contaminated teatcups was smaller: 20.4% versus 48.3% in farms without vaccination. There were no differences in proportions of contaminated teatcups between sampling occasions. In conclusion, the great majority of staphylococci recovered from teatcups of milking parlours in sheep and goat farms included biofilm-forming isolates. Reduced staphylococcal isolation was noted in farms where anti-staphylococcal vaccination was performed; this was possibly the effect of reduced excretion of staphylococci in the milk of vaccinated animals.

Extensive Countrywide Field Investigation of Somatic Cell Counts and Total Bacterial Counts in Bulk-Tank Raw Milk in Sheep Flocks in Greece.

Objectives were to investigate somatic cell counts (SCC) and total bacterial counts (TBC) in the raw bulk-tank milk of sheep flocks in Greece, to study factors potentially influencing increased SCC and TBC in the bulk-tank milk of sheep and to evaluate possible associations of SCC and TBC with milk content. Throughout Greece, 325 dairy sheep flocks were visited for collection of milk sampling for somatic cell counting, microbiological examination and composition measurement. Geometric mean SCC were 0.488 × 106 cells mL-1; geometric mean TBC were 398 × 103 cfu mL-1; 228 staphylococcal isolates were recovered form 206 flocks (63.4%). Multivariable analyses revealed annual incidence risk of clinical mastitis, age of the farmer and month into lactation period (among 53 variables) to be significant for SCC > 1.0 × 106 cells mL-1 and month into lactation period at sampling and availability of mechanical ventilators (among 58 variables) to be significant for TBC > 1500 × 103 cfu mL-1. Negative correlation of SCC with fat, total protein and lactose and positive correlation of SCC with added water were found. With SCC > 1.0 × 106 cells mL-1, significant reduction of protein content (2%) was observed, whilst in flocks with SCC > 1.5 × 106 cells mL-1, significantly lower annual milk production per ewe (42.9%) was recorded.

Retroperitoneal ganglioneuroma causing chronic lower back and leg pain in an 80-year-old man: A case report.

INTRODUCTION: and importance: Retroperitoneal ganglioneuromas that cause lower back and leg pain are extremely rare and are often misdiagnosed. Surgical resection has excellent prognosis in long-term survival. CASE PRESENTATION: We present an 80-year-old man with two-year worsening left lower back and leg pain. He was treated as presumed lumbar spine spondylosis with several courses of physical therapy together with medical treatment. An abdomen CT scan disclosed a tumour in the left retrorenal space. The tumour was resected and the histopathologic examination suggested a completely excised retroperitoneal ganglioneuroma. During one-year follow-up the patient is free of pain without any local recurrence. CLINICAL DISCUSSION: Retroperitoneal ganglioneuromas are rare benign tumors that originate from neural crest-derived cells of the paravertebral sympathetic plexus and sometimes from the adrenal medulla. They are usually asymptomatic and discovered on routine clinical examination or on autopsy. Occasionally they may show symptoms due to local pressure effect or rarely they are hormonally active and present with adrenergic symptoms. Complete resection of the tumor is important in order establish the final diagnosis and alleviate symptoms from pressure effects. CONCLUSION: This case highlights the need for great vigilance among physicians in order to consider any possible retroperitoneal pathology when indicated in the differential diagnosis of lower back and leg pain, before establishing other more common diagnosis, especially in the older population.

Streptococcus spp. from bulk-tank milk and milking machine teatcups on small ruminant farms, and factors potentially associated with their isolation.

The objectives of this work were (a) to determine the presence of streptococci in samples from small ruminant dairy farms (bulk-tank milk and, where possible, teatcup swabs), (b) to investigate the potential adverse effects of streptococci on milk quality and (c) to investigate the importance of some husbandry factors for the isolation of streptococci. Bulk-tank milk samples and teatcups swab samples were examined bacteriologically for the presence of streptococci. Somatic cell counting and milk composition measurements were also performed. The husbandry factors present in each farm were assessed for potential associations with the isolation of streptococci. Streptococci were isolated from milk samples from 31.4% of sheep and 17.4% of goat farms and from 4.8% of sheep and 5.9% of goat teatcups. Streptococci were isolated more frequently from the upper part than the lower part of teatcups: 5.0% vs. 1.9%. Most isolates (57.9%) were identified as Streptococcus uberis. Most isolates (68.4%) were slime-producing; slime-production was more frequent among isolates from teatcups (83.3%) than from bulk-tank milk (55.0%). Somatic cell counts and milk composition did not differ between farms in which streptococci were or were not isolated. Machine-milking was associated with the isolation of streptococci from bulk-tank milk samples. The initial stage of the milking period (first two months) was found to be associated with the isolation of streptococci from milking machine teatcups in sheep farms only.

A Detailed Questionnaire for the Evaluation of Health Management in Dairy Sheep and Goats.

The objective of this work was to develop, use and present a detailed questionnaire for the evaluation of health management in dairy small ruminants; it includes 442 questions organised in seven sections: general, infrastructure, animals, production characteristics, health management, nutrition, human resources. Consistency of replies was evaluated in 27 farmers, interviewed twice. Inconsistent replies were given by all farmers to 30 different questions (Cronbach's coefficient alpha: 0.987). Then, interviews were performed in 444 farms around Greece. Mean duration of an interview was 63.6 min. Clarifications were requested by 273 farmers to 22 different questions (maximum per farmer: 8). The experience of the investigator, the primary language of farmers and asking clarifications by the farmers affected the duration of the interview. The questionnaire can be used for research work in the field, to record details in the farms under study. In accord with the needs of a particular study, it can be modified, by adding more specific questions or omitting others deemed of less importance. Moreover, it can also be used for routine monitoring purposes, as a useful means to record and maintain details of farms during clinical work. To the best of our knowledge, the questionnaire is the most extensive and detailed one available internationally for dairy small ruminants.

Mammary Defences and Immunity against Mastitis in Sheep.

The objectives of this review paper are to present udder defences, including teat of the udder, mammary epithelial cells, leucocytes, immunoglobulins, complement system and chemical antibacterial agents, to describe cooperation and interactions between them and to elaborate on potentials regarding their significance in mammary immunisation strategies. The teat of the udder provides initial protection to the mammary gland. The mammary epithelial cells synthesise antibacterial proteins and the leucocytes produce various inflammation mediators (cytokines or chemokines), phagocytose bacteria and recognise antigenic structures. In the mammary gland, four immunoglobulins (IgG1, IgG2, IgM and IgA) have important roles against bacterial pathogens. The complement system is a collection of proteins, participating in the inflammatory process through various pathways. Other components contributing to humoral mammary defence include lactoferrin, lysozyme and the lactoperoxidase/myeloperoxidase systems, as well as oligosaccharides, gangliosides, reactive oxygen species, acute phase proteins (e.g., haptoglobin and serum amyloid A), ribonucleases and a wide range of antimicrobial peptides. Management practices, genetic variations and nutrition can influence mammary defences and should be taken into account in the formulation of prevention strategies against ovine mastitis.

Posteromedial rotatory incongruity of the elbow: a computational kinematics study.

BACKGROUND: Our objective was to analyze the effect of different anteromedial coronoid fracture patterns with different combinations of ligamentous repairs. We hypothesized that smaller fractures would be sufficiently treated with ligamentous repair alone but that larger fragments would require a combination of ligament and bony repair versus reconstruction. METHODS: Two multibody models were created from cadaveric specimens in the ADAMS program. Four different conditions were simulated: (1) no fracture, (2) O'Driscoll anteromedial subtype I (2.5-mm) fracture, (3) subtype II 2.5-mm fracture, and (4) subtype II 5-mm fracture. In each of these conditions, 3 ligament repairs were studied: lateral ulnar collateral ligament (LUCL), posterior bundle of the medial collateral ligament (pMCL), and both LUCL and pMCL. For each condition, kinematics and articular contact areas were calculated. RESULTS: LUCL repair alone increases whereas pMCL repair decreases internal rotation of the ulna relative to all tested posteromedial rotatory instability conditions; their rotational effects are summative when both ligaments are repaired. With a subtype I fracture and both pMCL and LUCL injuries, repairing the LUCL alone corrects angulation whereas rotational stability is satisfactory through the arc from 0° to 90°. In a subtype II 2.5-mm fracture, isolated repair of the LUCL or pMCL is not capable of restoring rotation or angulation. For a subtype II 5-mm fracture, no combination of ligamentous repairs could restore rotation or angulation. CONCLUSIONS: This study suggests that LUCL repair alone is sufficient to restore kinematics for small subtype I fractures for an arc avoiding deep flexion; whereas nearly normal kinematics throughout the arc of motion can be achieved if the pMCL is also repaired. Larger anteromedial coronoid fractures should ideally have fragments fixed in addition to ligament repairs.

Medial Collateral Ligament Deficiency of the Elbow Joint: A Computational Approach.

Computational elbow joint models, capable of simulating medial collateral ligament deficiency, can be extremely valuable tools for surgical planning and refinement of therapeutic strategies. The objective of this study was to investigate the effects of varying levels of medial collateral ligament deficiency on elbow joint stability using subject-specific computational models. Two elbow joint models were placed at the pronated forearm position and passively flexed by applying a vertical downward motion on humeral head. The models included three-dimensional bone geometries, multiple ligament bundles wrapped around the joint, and the discretized cartilage representation. Four different ligament conditions were simulated: All intact ligaments, isolated medial collateral ligament (MCL) anterior bundle deficiency, isolated MCL posterior bundle deficiency, and complete MCL deficiency. Minimal kinematic differences were observed for isolated anterior and posterior bundle deficient elbows. However, sectioning the entire MCL resulted in significant kinematic differences and induced substantial elbow instability. Joint contact areas were nearly similar for the intact and isolated posterior bundle deficiency. Minor differences were observed for the isolated anterior bundle deficiency, and major differences were observed for the entire MCL deficiency. Complete elbow dislocations were not observed for any ligament deficiency level. As expected, during isolated anterior bundle deficiency, the remaining posterior bundle experiences higher load and vice versa. Overall, the results indicate that either MCL anterior or posterior bundle can provide anterior elbow stability, but the anterior bundle has a somewhat bigger influence on joint kinematics and contact characteristics than posterior one. A study with a larger sample size could help to strengthen the conclusion and statistical significant.

Musculoskeletal Model Development of the Elbow Joint with an Experimental Evaluation.

A dynamic musculoskeletal model of the elbow joint in which muscle, ligament, and articular surface contact forces are predicted concurrently would be an ideal tool for patient-specific preoperative planning, computer-aided surgery, and rehabilitation. Existing musculoskeletal elbow joint models have limited clinical applicability because of idealizing the elbow as a mechanical hinge joint or ignoring important soft tissue (e.g., cartilage) contributions. The purpose of this study was to develop a subject-specific anatomically correct musculoskeletal elbow joint model and evaluate it based on experimental kinematics and muscle electromyography measurements. The model included three-dimensional bone geometries, a joint constrained by multiple ligament bundles, deformable contacts, and the natural oblique wrapping of ligaments. The musculoskeletal model predicted the bone kinematics reasonably accurately in three different velocity conditions. The model predicted timing and number of muscle excitations, and the normalized muscle forces were also in agreement with the experiment. The model was able to predict important in vivo parameters that are not possible to measure experimentally, such as muscle and ligament forces, and cartilage contact pressure. In addition, the developed musculoskeletal model was computationally efficient for body-level dynamic simulation. The maximum computation time was less than 30 min for our 35 s simulation. As a predictive clinical tool, the potential medical applications for this model and modeling approach are significant.

Ulna-humerus contact mechanics: Finite element analysis and experimental measurements using a tactile pressure sensor.

Elbow articular cartilage withstands high compressive and shear forces while protecting the bone from excessive loading. Better understanding of elbow cartilage contact mechanics can provide insight into cartilage degeneration. In this study a tactile pressure sensor was used to measure the contact pressure distribution within the ulno-humeral joint of two cadaver specimens at 20° flexion angle across three different axial loads of 80 N, 110 N, and 140 N. Corresponding 3D finite element (FE) models were constructed from magnetic resonance imaging (MRI) and contact analysis was performed for each specimen with boundary and loading conditions identical to the experiment. Direct comparison between FE results and experimental measurements was conducted for the validation of the FE models and a sensitivity analysis was employed for assessing the effect of cartilage parameters on the model's outputs. The results showed a good agreement between the FE models and the experiments in terms of contact characteristics. The sensitivity analysis demonstrated that outcomes of the model, particularly peak contact pressure is more sensitive to the Poisson's ratio rather than to Young's modulus under static conditions. This result suggests that selection of Poisson's ratio is very critical for accurate prediction of contact mechanics within the ulno-humeral joint.

Cardiac ultrasonography over 4G wireless networks using a tele-operated robot.

This Letter proposes an end-to-end mobile tele-echography platform using a portable robot for remote cardiac ultrasonography. Performance evaluation investigates the capacity of long-term evolution (LTE) wireless networks to facilitate responsive robot tele-manipulation and real-time ultrasound video streaming that qualifies for clinical practice. Within this context, a thorough video coding standards comparison for cardiac ultrasound applications is performed, using a data set of ten ultrasound videos. Both objective and subjective (clinical) video quality assessment demonstrate that H.264/AVC and high efficiency video coding standards can achieve diagnostically-lossless video quality at bitrates well within the LTE supported data rates. Most importantly, reduced latencies experienced throughout the live tele-echography sessions allow the medical expert to remotely operate the robot in a responsive manner, using the wirelessly communicated cardiac ultrasound video to reach a diagnosis. Based on preliminary results documented in this Letter, the proposed robotised tele-echography platform can provide for reliable, remote diagnosis, achieving comparable quality of experience levels with in-hospital ultrasound examinations.

Prediction of elbow joint contact mechanics in the multibody framework.

Computational multibody musculoskeletal models of the elbow joint that are capable of simultaneous and accurate predictions of muscle and ligament forces, along with cartilage contact mechanics can be immensely useful in clinical practice. As a step towards producing a musculoskeletal model that includes the interaction between cartilage and muscle loading, the goal of this study was to develop subject-specific multibody models of the elbow joint with discretized humerus cartilage representation interacting with the radius and ulna cartilages through deformable contacts. The contact parameters for the compliant contact law were derived using simplified elastic foundation contact theory. The models were then validated by placing the model in a virtual mechanical tester for flexion-extension motion similar to a cadaver experiment, and the resulting kinematics were compared. Two cadaveric upper limbs were used in this study. The humeral heads were subjected to axial motion in a mechanical tester and the resulting kinematics from three bones were recorded for model validation. The maximum RMS error between the predicted and measured kinematics during the complete testing cycle was 2.7 mm medial-lateral translation and 9.7° varus-valgus rotation of radius relative to humerus (for elbow 2). After model validation, a lateral ulnar collateral ligament (LUCL) deficient condition was simulated and, contact pressures and kinematics were compared to the intact elbow model. A noticeable difference in kinematics, contact area, and contact pressure were observed for LUCL deficient condition. LUCL deficiency induced higher internal rotations for both the radius and ulna during flexion and an associated medial shift of the articular contact area.

Lateral collateral ligament deficiency of the elbow joint: A modeling approach.

A computational model capable of predicting the effects of lateral collateral ligament deficiency of the elbow joint would be a valuable tool for surgical planning and prediction of the long-term consequences of ligament deficiency. The purpose of this study was to simulate lateral collateral ligament deficiency during passive flexion using a computational multibody elbow joint model and investigate the effects of ligament insufficiency on the kinematics, ligament loads, and articular contact characteristics (area, pressure). The elbow was placed initially at approximately 20° of flexion and a 345 mm vertical downward motion profile was applied over 40 s to the humerus head. The vertical displacement induced flexion from the initial position to a maximum flexion angle of 135°. The study included simulations for intact, radial collateral ligament deficient, lateral ulnar collateral ligament deficient, and combined radial and lateral ulnar collateral ligament deficient elbow. For each condition, relative bone kinematics, contact pressure, contact area, and intact ligament forces were predicted. Intact and isolated radial collateral ligament deficient elbow simulations were almost identical for all observed outcomes. Minor differences in kinematics, contact area and pressure were observed for the isolated lateral ulnar collateral ligament deficient elbow compared to the intact elbow, but no elbow dislocation was detected. However, sectioning both ligaments together induced substantial differences in kinematics, contact area, and contact pressure, and caused complete dislocation of the elbow joint. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1645-1655, 2016.

Education, training, and professional issues of radiographers in six European countries: a comparative review.

Radiographers constitute an important part of a multidisciplinary radiation-based imaging and therapy chain. However, is there a common framework for assuring high education, training, and subsequent practice of profession among European countries? A study was conducted, based on a questionnaire that consisted of three parts, concerning education and training (Part A), national registry (Part B), and professional issues (Part C). Analysis of the collected data suggested that a common policy is generally followed in the countries investigated; however, differences were not negligible. A common framework of educational programmes among European countries could form the basis for overall standardisation at national and international level.